Dr. Ragneel Bijjula inside the Carson Tahoe Cancer Center on Sept. 19, 2023.
Photo by Scott Neuffer.
In hiring upward of 20 doctors and providers this year, Carson Tahoe Health officials are hoping to address pressing needs in the community.
“We’ve got close to 20 different providers that we’re bringing on board between the end of July through the end of this year, essentially, which is huge for this area,” said Ryan Patton, vice president of CTH Physician Group.
Patton and other staff members met the Appeal at the Carson Tahoe Cancer Center on Sept. 20. Located off Medical Parkway just above the main hospital, the cancer center is quiet and peaceful, which is not to say patients inside are having an easy time. How to better serve all patients in the community was at the heart of the discussion.
The diagnosis
Patton called Nevada “a healthcare desert.” He emphasized how desolate the situation in the Silver State is.
“For PCPs (primary care providers), depending on what study or survey you look at, we’re usually 48, 49, even 50 out of all 50 states in people being able to get in to see a provider,” he said. “It’s just because of the sheer lack of physicians here in Nevada.”
An assessment conducted last year by Carson Tahoe Health and Carson City Health and Human Services brought hundreds of survey participants, stakeholders and focus groups together to shine light on healthcare needs in the community. The assessment followed the COVID-19 pandemic, which exacerbated health issues across the quad county region that includes Carson City, Douglas, Lyon and Storey counties.
Four priority needs were identified: access to basic needs like primary healthcare and housing; mental and emotional health; access to healthcare for specific populations; and substance use prevention, treatment and recovery.
According to the assessment, low-income and underinsured individuals have been seeing wait times of up to four months for primary care.
“It’s not just underserved or underinsured patients that are having difficulties getting in,” Patton said. “We see anybody, basically, here with Carson Tahoe, but even the insured patients are having trouble getting into primary care because there’s just that lack of physicians.”
Patton estimated Carson Tahoe has about 100 to 120 providers, including doctors and advanced practice clinicians like nurse practitioners. Of the 20 or so providers joining the team this year, only three are for primary care.
“We could use 10 more, quite frankly, or more than that,” he said. “The three are not going to make a big enough dent.”
Patton said Caron Tahoe is still heavily recruiting for primary care.
“For primary care, I don’t have a number, honestly,” he said. “I would entertain anybody who is qualified and wants to come to the area. We kind of got set numbers for some of the specialties we’re looking for, because we don’t want to oversaturate the area, but primary care at this point … Until we get to the point where it is easier for any patient to get into see a doctor fairly quickly, then we got a problem. We got a need we’re trying to meet.”
Patton said the situation is worse in rural parts of the state.
“We’re pretty lucky that we’re close here in Carson with Reno and everything, but we’re doing everything we can to even help service those more rural locations,” he said. “We have clinics in Minden and in Dayton now for primary care, and then we got specialists that go out down into Mammoth, Elko to Yerington, to try to provide those patients with care … We scatter pretty far.”
Finding the cure
As city and hospital officials work on a community health improvement plan that targets gaps in service, Patton wants to lure the best doctors and providers to Carson.
“Employing providers is the main tool that I have,” he said.
Successfully recruiting doctors means offering competitive pay but also flexibility in work scheduling, he said.
“So, we’re very competitive in our compensation, but what I found is we’re very flexible with our providers as well,” he said.
Patton said many providers want a four-day workweek comprised of 10-hour shifts. He explained Carson offers an active outdoor lifestyle many desire.
“Being able to be flexible with providers and their scheduling is important,” he said. “I find that here in our area, that has a significant importance to providers because they do want to get out on the trails. They want to be out on the slopes during the season, you know. So, they find they can come in, work their four 10-hour shifts and then get out and have fun in the meantime.
“We really try to sell that lifestyle and the quality of life that we want our providers and our staff in general to have as well.”
Patton also discussed a recent restructuring. In June, CTH closed Walmart clinics in Carson and Gardnerville due to low patient volumes. However, the group opened walk-in clinics in other locations.
“We closed the Walmart clinics June 1 and simultaneously opened up our walk-in clinics,” Patton said.
One is located in the Eagle Medical Center at 2874 Carson St., Suite 200, and the other is located at 925 Ironwood Drive, Suite 2102, in Minden.
“When you’re unable to secure an appointment with your primary care provider on short notice, our walk-in clinics are here to help,” says the CTH website.
The clinics are open 8 a.m. to 5 p.m. Monday through Friday and focus on nonemergency issues like cold or flu symptoms. More information is online: https://www.carsontahoe.com/walk-in-clinics.html.
“It’s just a different setting, but it’s also a different way that we bill things, so it’s actually more economical for our patients to be seen in the walk-in clinics,” said Patton.
Like primary care, specialty care can be a challenge. Patton said CTH has been recruiting for cardiology, neurology, oncology and gastroenterology, among other areas. He spoke to mental healthcare needs as identified in the recent assessment, noting more psychologists and therapists are needed.
“We’ve got a pretty robust behavioral health system here within Carson Tahoe, but we’re looking to expand and grow that,” he said.
He stressed Carson Tahoe is a community hospital:
“Carson Tahoe is trying to do everything we can to support our community because we are a community hospital, and we want to be able to provide the care patients need here at home, so that they don’t have to travel so far.”
New Faces
Dr. Ragneel Bijjula, 40, is a new oncologist at the cancer center. His wife, Dr. Kirthi Reddy, just started with the group as a gastroenterologist. The couple recently relocated from West Virginia to south Reno.
“I visited Reno and Carson quite a few times before,” Bijjula said.
Family was one reason for the move, he said. His uncle is a professor at the University of Nevada, Reno, and Reddy has family in the area.
“Number two, even West Virginia is beautiful, but here, we have mountains and hills, and we don’t have sun there,” he said.
Bijjula finds the Carson region sunnier, outdoorsy and with “more hiking spots.” He said he’s found Nevadans hardy, hardworking and proud. However, he expressed concern Nevadans smoke too much.
“The biggest deficiency I’ve seen in the short window I’ve been here is lung cancer screening,” he said.
CTH reduced lung cancer screening rates in September for patients that qualify. Bijjula believes prevention is important but said people have misconceptions about cancer treatment.
“I think one of the most common misconceptions is once you have a cancer diagnosis that it’s the death sentence, which is not the case because it really depends on what kind of cancer it is,” he said. “I have patients whose cancer is cured, and they’re living their lives normally for a long time.”
Bijjula described building rapport with patients, which he called essential.
“In terms of the oncology field, you have to have really good rapport and bond with patients,” he said. “My treatments are not going to work that well if I don’t have good rapport with patients.”
Becoming part of the community as a healthcare provider, Bijjula pointed to the same quality of life that Patton hopes attracts doctors to the area. He said treatment prolongs life and improves quality of life. He gave the example of a grandparent being able to lift their grandchild.
“People still want to go out and do things like they normally want to,” he said. “They want to garden. They want to go out for a walk. They want to go out to meet family and friends.”
Bijjula looked hopeful as he talked. He said if someone followed him around the clinic, “you’ll find there are more patients who are cured than not.”
For information about Carson Tahoe, a not-for-profit healthcare system and affiliate of University of Utah Health, visit www.CarsonTahoe.com.